公共财政体系与农村新型合作医疗筹资水平研究——促进公共服务横向均等化的制度思考

新型农村合作医疗(新农合)的筹资主要来自政府补助。对于很多县级政府来说,其新农合筹资来自上级政府(主要是中央政府和省级政府)的补助金,这对于新农合的平稳实施至关重要。然而,由于新农合补助金是一种带有配套要求的专项补助,而上级政府大多采用一刀切式的固定金额补助法,这样财力较弱、农业人口比重高的地方政府不得不承担相对较大比重的筹资责任。为了发挥上级政府补助金推进地方政府财力横向均等化的作用,促使财力不同的地方政府为民众提供大体相同的新农合服务,有必要在政府间转移支付上探寻更为制度化的方法。

Public Finance System and Financing of New-type Cooperative Medical Schemes in Rural China——A Reflection on Horizontal Equalization of Public Services

New type cooperative medical schemes(NCMSs)in rural China are financed mainly by government subsidies.For many county governments,the subsidies mainly from the governments at the provincial and central levels are critical to the smooth implementation of the schemes.Since the NCMS subsidies are appropriated as a categorical grant with matching requirement and fixed rate,local governments with high proportion of agricultural population and weak financial strength have to bear heavier financing responsibility for the schemes.Therefore,the government subsidies from the provincial and central levels must play a role of equalizing local financial capacities so as to provide relatively equal health care security services to local people of different financial situations.To do so,more institutionalized fiscal arrangement for inter government transfers should be explored.